| NPI | 1366567539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 8609) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 2232) |
| 1223G0001X Dentist General Practice (Licence: TX 34542) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2022-11-01 |